Pain – Movement

By Damien Howell

If pain occurs with movement, then observation and analysis of movement is required. The measurement of the symptom of pain occurs using the familiar numeric pain scale (zero to 10). In 1996 the American Pain Society lead a campaign to consider the measurement of pain as the 5th vital sign. The 5th vital sign became…

Read More

“Deme Bones” – inter-limb deviation related to the musculoskeletal pain syndromes

By Damien Howell

“The toe bone is connected to the foot bone” is the common reframe from the old gospel song “Dem Bones.” The concept of mechanical connectedness or regional interdependence applied to musculoskeletal pain syndromes suggests that in addition to examining a patient’s local area of complaint examination of the adjacent joints above and below the primary…

Read More

Should we discharge from Physical Therapy

By Damien Howell

Why is the terminology “discharged from Physical Therapy” used? I have not heard of anyone being “discharged from dentistry”. I have not heard of anyone being discharged from massage therapy. The meaning of “discharge” is – to relieve of a charge, load, or burden; or to release from confinement, custody, or care; or to set…

Read More

Half Seat Lateral Wedge for Lateral Pelvic Tilt Sitting

By Damien Howell

Shoe lifts or lifts in the shoe are a common treatment for leg length discrepancy. Why are lifts not used for lateral pelvic tilt when sitting? In a previous blog article, I described lateral pelvic tilt and anatomical versus functional lateral pelvic tilt. Lateral pelvic tilt can result from individual structural variation, and defective chair or…

Read More

What is harder than learning? Unlearning

By Damien Howell

This image from Roger von Oech’s “A whack on the side of the head” 1983 has intrigued me for years. The idea that we get rid of ideas or concepts is thought-provoking. How do we know when to reject ideas? What is the thought process we use to unlearn something? My understanding of learning new…

Read More

How to better engage with healthcare provider using telehealth care

By Damien Howell

Telemedicine electronic medical record patient portals and email provide opportunities for improved communication between patients and healthcare professionals. As a patient: As a patient with a chronic condition rheumatoid arthritis, I have found using an email patient portal to communicate with my healthcare providers is highly effective and efficient. Prior to my scheduled appointment, I…

Read More

On-line mentoring reflective learning

By Damien Howell

John Dewy wrote, “the experience alone does not necessarily lead to learning; it is the reflection that makes sense of the experience to us and hence makes the experience meaningful for us”. Experience does not equal learning.  We do not learn from experience we learn from reflection on experience. Experience does not equal knowledge. Reflection…

Read More

Plantar fasciitis v tendinopathy words matter – stretching exercises are overrated

By Damien Howell

Why is the plantar region the only region of the body where the terminology of fasciitis is used? Fascial tissue is present throughout the body including the ankle, knee, hip, back, and abdominal regions of the body. Yet, we do not use the term knee fasciitis or back lumbar fasciitis. We know that stretching exercises…

Read More

Choices of interventions for musculoskeletal pain syndromes: decrease pain, improve impairment, resolve dysfunction

By Damien Howell

There are multiple and varied interventions that can tackle the contributing factors of pain, impairment, and dysfunction that occurs with musculoskeletal pain syndromes. Pain impairs an individual’s ability to function Impairment is loss of use or derangement of any body part, organ system, or organ function. Dysfunction is an alteration of an individual’s capacity to…

Read More